Medical schemes will only provide top-up cover under the NHI, there will be a central fund established to pay for the NHI, and doctors could choose to participate in this scheme if they wanted to.

Under the NHI, medical schemes will only
offer top-up cover for those services not covered by the NHI, the NHI will be
funded through a central fund (partially funded from a payroll levy), medical
brokers will be done away with (they currently receive R1.5 billion rand per
year), and doctors will be able to access the central fund if they choose to
participate in the NHI.

These were some of the key announcements
made by Health Minister Aaron Motsoaledi at the release of the White Paper on
National Health Insurance at a press conference in Pretoria.

The NHI will not be a sprint, but will be
an ultramarathon, said Motsoaledi.

The Cabinet met on 9 December, and it was
presumed that the NHI White Paper was on the agenda, as it was later confirmed
that the cabinet had approved the White Paper, and that public comment would be
invited.

The
purpose of the NHI

National Health Insurance “seeks to
transform the South African Healthcare system with emphasis on the promotion of
health and the prevention of diseases. It also seeks to provide access to
quality and affordable healthcare services for all South Africans based on
their health needs irrespective of their socio-economic status”, according to the
South African Government website.

The government green paper was released in
August 2011, and it proposed that the NHI would be implemented within 14 years.
Pilot districts were established in all nine provinces.

Where
will the money come from?

The cost of implementing the NHI is
projected to R225 billion by 2025. Possibilities of raising these funds,
according to reports from 2012, include a pay roll levy for all employed South
Africans, and increase in VAT, or an income tax surcharge. These possible
sources of revenue were confirmed on Friday by Motsoaledi in the press
conference in Pretoria.

SA’s economy is under increasing pressure,
and how the government proposes to fund the NHI is a topic of interest for all
South Africans. Another issue is how the public and private health sectors will
function alongside one another, and what the future would be of medical schemes
in South Africa. Motsoaledi announced on Friday that under the NHI, medical
schemes will only offer top-up cover for those services not covered by the NHI.

There are state hospitals that would need a
serious upgrade and in 2013 President Zuma proposed that this would be
undertaken through public-private partnerships. Motsoaledi confirmed in
Friday’s address that you can’t have a proper healthcare service without a
proper healthcare infrastructure. He has also consistently attacked private
hospitals for the high cost of the care they provide, saying that this
contributes to high medical inflation.

“Everyone wants to own a private hospital
in SA, because they say there is money in it”, he said on Friday. He also
mentioned that most European countries are moving to mandatory universal
healthcare coverage and compared Obamacare to what the NHI is trying to achieve
in South Africa.

The minister has expressed ongoing concern
about the fact that 80% of the medical specialists in the country are servicing
only 16% of the population – something the NHI is set to address. One of the
ways of achieving this would be requiring doctors to show a certificate of need
before being allowed to practise in certain areas. There is still no certainty
with regards to the implementation of this.

Read about the possibility of the
certificate of need being implemented under the NHI and what it would mean to
doctors.

Concerns raised by commentators on the NHI
include financial constraints of already overburdened taxpayers, the possible
exodus of medical staff from the private sector to other countries, the poor
condition of many state facilities, the lack of properly trained managers and
the lack of trained medical staff willing to work in rural areas.

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The information on Health24 is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional. See additional information.